| |
4600 Mcmasters Ave Hannibal MO 63401-2244 | |
(573) 603-1460 | |
(573) 603-1462 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 4600 Mcmasters Ave, Hannibal, Missouri |
Authorized Official Name and Position | Mark Conover (CHIEF REVENUE OFFICER) |
Authorized Official Contact | 6606651962 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1601 Old South River Rd Saint Charles MO 63303-4120 Ph: (636) 224-1210 | 4600 Mcmasters Ave Hannibal MO 63401-2244 Ph: (573) 603-1460 |
NPI Number | 1619490745 |
---|---|
Provider Enumeration Date | 07/20/2017 |
Last Update Date | 07/29/2022 |
Medicare PECOS PAC ID | 0244256246 |
---|---|
Medicare Enrollment ID | O20170822002314 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619490745 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Marion County Health Dept. & Home Health Agency Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3105 Rt. W, Hannibal, MO 63401 Phone: 573-221-1166 Fax: 573-221-1214 | |